Urinary Incontinence Assessment in Older Adults Part I – Transient ...

Urinary Incontinence Assessment in Older AdultsBLADDER DIARY/RECORD - Track a 24-hour time period for several daysP.M. Hours A.M. HoursTimeInterval12:00–01:00 AM01:00–02:00 AM02:00–03:00 AM03:00–04:00 AM04:00–05:00 AM05:00–06:00 AM06:00–07:00 AM07:00–08:00 AM07:00–08:00 AM09:00–10:00 AM10:00–11:00 AM11:00–12:00 PM12:00–01:00 PM01:00–02:00 PM02:00–03:00 PM03:00–04:00 PM04:00–05:00 PM05:00–06:00 PM06:00–07:00 PM07:00–08:00 PM08:00–09:00 PM09:00–10:00 PM10:00–11:00 PM11:00–12:00 AMFeeling aFull BladderVolumeUrintaedinToiletIncontinentEpisode 1Reason forEpisode 2Type andAmountofLiquidIntake 3BowelMovement1Incontinent episodes: (++) = SMALL: did not have to change pad/ clothing; (+++) = LARGE: needed to change pad/clothing2Examples of reasons for incontinent episodes: leaked while sneezing; leaked while running to the bathroom3Examples of type and amount of liquid intake: 12 oz can of cola, 2 cups regular coffee4Examples of product use: pad, undergarment; track times you changedProductUse 4Adapted from: Fantl, A., Newman, D.K., Colling, J., et al (1996). Urinary incontinence in adults: Acute and chronic management. Clinical Practice GuidelineNo. 2. AHCPR Publication No. 96-0682. Rockville, MD: Agency for Health Care Policy and Research, U.S. Department of Health and Human Services.Adapted from: U.S. Department of Health and Human Services, National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) Daily BladderDiary site (Updated 2010): http://kidney.niddk.nih.gov/kudiseases/pubs/diary/index.aspx.DIAPPERSPOSSIBLE CAUSES OF TRANSIENT URINARY INCONTINENCETOILETEDDeliriumInfection (e. g., urinary tract infection)Atrophic urethritis or vaginitisPharmacology (e.g., diuretics, anticholinergics, calciumchannel blockers, narcotics, sedatives, alcohol)Psychological disorders (especially depression)Endocrine disorders (e.g., heart failure, uncontrolled diabetes)Restricted mobility (e.g., hip fracture population, environmentalbarriers, restraints)Stool ImpactionThin, dry vaginal and urethral epithelium(Atrophic urethritis or vaginitis)Obstruction (Stool Impaction/Constipation)InfectionLimited mobility (Restricted mobility)Emotional (Psychological, Depression)Therapeutic medications (Pharmacological)Endocrine disordersDelirium(Information in parenthesis refers to the DIAPPERS mnemonic)Source for DIAPPERS mnemonic: Resnick, N.M. & Yalla, S.V. (1985). Management of Urinary Incontinence in the Elderly. NEJM, 313(800-804).Copyright 1985 Massachusetts Medical Society. All rights reserved. Adapted with permission.Annemarie Dowling-Castronovo, a Jonas Nurse Leaders Scholar (2010-2012), wishes to acknowledge that the development of this document was funded inpart by the Jonas Center for Nursing Excellence.general assessment seriesBest Practices in NursingCare to Older AdultsA series provided by The Hartford Institute for Geriatric Nursing,New York University, College of NursingEMAIL hartford.ign@nyu.edu HARTFORD INSTITUTE WEBSITE www.hartfordign.orgCLINICAL NURSING WEBSITE www.ConsultGeriRN.org